Wealth, Health, and Wisdom

Wealth, Health, and Wisdom

Preventive Medicine Column

Dr. David L. Katz

As I write this, I am flying back to the U.S. from Qatar – the richest country in the world. As such, it provides a vivid demonstration that money can’t buy you health any more than it can buy you love. The converse, in fact, appears to be true: the wealth of Qatar is being purchased at the cost of its people’s health.

I was invited to Qatar by colleagues at the branch of the Weil Cornell Medical Center (WCMC-Q) there, to speak at a symposium and meet with officials of the Supreme Council of Health of Qatar. I was there to share knowledge and insights in my area of expertise, but I got an education as well.

I knew before that obesity and chronic disease rates were high and rising fast in this part of the world. Not having made a study of Qatar before, I did not know that the prevalence of diabetes there is roughly twice as great as in the U.S., some 17% of the population as compared to our 8.3%. Given how often we speak of the United States as the veritable epicenter of the global obesity pandemic, I did not know that obesity prevalence was slightly but decisively higher in Qatar, at 40%, as is the overall prevalence of overweight and obesity at roughly 75%- and the rate of childhood obesity.

Several things make this relevant to us all, and worthy of our collective attention. First, the rapid rise of the very public health problems that bedevil the so-called West in a very different Middle-Eastern population highlight the extent to which vulnerability to these perils is universal. The perils of modern epidemiology are not national perils; they are human perils. As a species, we have no native defenses against the lure of the couch and caloric excess, and as a species, we succumb all too readily to both.

Second, the rapid development of these concerns in Qatar – over a span of years, not decades- indicates the potential folly of excessive focus on genetics or physiologic variation. It’s true, some of us are more vulnerable than others to obesity and type 2 diabetes alike, and genetic variation plays some part. But genes, hormones, and metabolic pathways have not changed in Qatar in a span of ten or twenty years. Changes that did not occur cannot be the explanation for changes that did. For the salient causes of salient effects, we must look for corresponding change-and we see it in the environment, and in culture.

Third, the recent advent of our home-grown epidemics some 7,000 miles away is a clear and compelling illustration of the power of culture, for the good or ill of health. When native culture and lifestyle prevailed in Qatar, there was little or no obesity. Foods were simple and close to nature, and physical activity was required for accessing water and managing animals.

Oil, and affluence, changed all of that. Qataris have the highest per capita income in the world. They have access to the world’s food, and the world’s technology. A diet limited to simple, wholesome, native foods and routine physical exertion are yesterday’s news. Today’s news is all about what happens when lifestyle runs off its traditional rails.

Qatar, then, is in crisis. A crisis borne of native vulnerability and imported menace. A crisis much like our own, but playing out over an accelerated time scale. Like all crises, this one harbors both danger and opportunity. The danger is clear enough. The opportunity is to introduce remedial programs and policies at a pace and scale commensurate with the threat. A small country of less than 2 million with a highly centralized authority, Qatar can, in theory at least, do this.

Qatari culture, though, much like our own, looks at the sharing of indulgent food as a way of demonstrating generosity and love. Their culture, like our own, harbors considerable ambivalence at best about physical activity. After all, it was their affluence that permitted them the luxury of exercising less.

But in their culture, as in ours, family members love one another. And there, as here, the consequences of unhealthy living –heart disease, cancer, stroke, dementia, and diabetes above all- have invaded almost every family. So they, as we, must update their culture, and the way they show love– or suffer the ever-worsening consequences.